People living with multiple sclerosis can benefit from a healthy diet, much like everyone else. While there is no one diet that is guaranteed to improve MS overall, there are some things you can do to help manage the many symptoms of this often complex disease.

Living with MS sometimes requires a degree of adaptation when it comes to one’s dietary choices, but evidence of the impact of those changes on improving or treating MS are inconclusive. MS presents itself differently in each person, and much like anything else relating to MS, it’s important that you work with your MS healthcare team to determine what works for your personal needs. You may want to include a nutritionist as part of your healthcare team for some advice on how to optimize your diet for those MS symptoms you are dealing with.

Conclusive evidence supporting the benefits of specific diets for MS is scarce and difficult to come by. (We are, however, excited by a recent clinical trial announcement by the National MS Society in the U.S. that is testing dietary treatment approaches to MS fatigue!) Research investigating the effects of diet on the cause and treatment of MS is challenging, as these types of studies are difficult to design and control for. Nutritional clinical trials have too many variables, unlike studying a specific drug that researchers can control for different chemical reactions. It is also difficult to find a large cohort of participants willing to follow a strict elimination diet for an extended period of time without cheating.

Despite this, we know from listening to people affected by MS that eating or eliminating certain foods appear to be helpful in managing symptoms, and as new research methods are developed and refined, we are learning more about the impact of diet on MS.

You may find that certain MS symptoms affect what you eat or how you prepare meals. With careful planning and with the support of your healthcare team, you can adapt your diet to best suit your MS symptoms and circumstances – even if they change over time. Changes to your symptoms and/or lifestyle might affect the foods you eat and your nutritional needs.

Living with certain MS symptoms can make regular tasks like shopping and meal preparation more taxing. For example, trips to the grocery store can make you tired or tremor can make chopping vegetables difficult. An occupational therapist can suggest energy-saving tips and helpful equipment or adaptations.

Here are some ways you can be mindful of diet based on certain symptoms of MS.

Bowel dysfunction

High-fibre foods help with constipation. Dietary changes are often suggested as the first line of treatment for people with MS who experience constipation. Good fluid intake can help regulate bowel function, as can a diet with plenty of insoluble fibre. This fibre cannot be digested and passes straight through the gut, helping digestion of other foods and removal of waste. A well-balanced diet with plenty of fruit and vegetables can provide this fibre. Prunes (or prune juice), figs, whole wheat bread, fibre-fortified white bread, brown rice, and high-fibre breakfast cereals are particularly good sources of insoluble fibre.

Bladder problems

Some people with bladder dysfunction drink less to reduce their need to use the toilet; however, drinking less can also lead to more concentrated urine, which can irritate the bladder and increase the chance of urinary tract infections. Less fluid intake can also cause bowel problems such as constipation. Drinking six to eight cups (about 1.5 litres) of water per day is generally recommended. It is best to avoid large quantities of caffeine and alcohol as these irritate the bladder.

Fatigue

You can help ease fatigue by adjusting the diet. Try opting for smaller meals or frequent snacks rather than a large, hot meal to help maintain energy levels. You may also try incorporating protein with all meals or snacks. Protein or complex carbohydrates such as wholegrain bread can also help keep energy levels up. Eating too many sugary foods for energy can make fatigue worse, as they cause energy peaks followed by lows. Dehydration can also lead to fatigue, so aim to drink six to eight cups (about 1.5 litres) of fluids per day. Drinks that contain a lot of caffeine, such as tea, coffee and soda can have an initial pick-me-up effect, but too much caffeine can dehydrate you.

Tremor

Tremor can affect your nutritional needs or your approach to eating. Moderate to severe tremor uses up calories, so high-energy foods and drinks between meals might be necessary to avoid weight loss or worsening fatigue. If tremor affects holding or reaching for things, certain foods may be easier to eat than others. A sandwich, for example, is easier to manage than spaghetti or soup. Specially designed cutlery, dinnerware and kitchen utensils can make the preparation and eating of food more manageable.

Swallowing problems

Dietary modifications for this symptom require a balance between improving/maintaining nutrition while ensuring that swallowing is safe. Modifying food textures may help, since some foods are swallowed more easily than others. For example, sometimes a thickening agent or a gelatin must be added to meals. Nuts should be limited because they can stick in the throat and may be irritating. Semisolid food is the easiest to swallow. In more difficult cases, food may need to be puréed. If none of these techniques is effective, a feeding tube can be inserted into the stomach through the nose or directly into the stomach, surgically, to maintain adequate nutrition.

A note on weight management

Immobility and fatigue can lead to unintentional weight gain. To manage your weight, strive to achieve a balance between calories, exercise, and rest. This may mean eating smaller meals, more frequently, or reducing your overall caloric intake.

Please note that special diets should be discussed with a healthcare professional who can advise on the safety and effects of the diet on MS.